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Pediatric scaphoid fractures: predictors of surgery and fracture complications
Vandan S Patel1,2, Lewis Fanney1,3, Carlos Yaya-Quezada1
1Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Insights
Pediatric scaphoid fractures requiring surgery are predicted by delayed radiographic evaluation, displacement, and proximal pole involvement. These findings aid in surgical decision-making for pediatric wrist injuries.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Radiology
Background:
- Scaphoid fractures are the most common carpal bone fractures in children.
- Predicting the need for surgical intervention in pediatric scaphoid fractures is crucial for optimal outcomes.
- Identifying specific radiographic predictors can guide treatment decisions.
Purpose of the Study:
- To determine clinical and radiographic indicators of pediatric scaphoid fractures that necessitate surgical treatment.
- To differentiate between surgically and conservatively managed pediatric scaphoid fractures based on imaging findings.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) with scaphoid fractures treated between 2018 and 2024.
- Comparison of fracture characteristics between surgically and conservatively treated groups, including skeletal age, location, displacement, and resorption.
- Logistic regression analysis to identify independent predictors of surgical treatment.
Main Results:
- Displaced fractures (81.3% vs. 12.2%) and articular involvement (37.5% vs. 8.3%) were significantly more common in the surgery group.
- Proximal pole fractures (OR=6.67), fracture displacement (OR=6.30), and delayed radiographs (OR=1.08) were independent predictors of surgery.
- Lobulated perifracture resorption was highly prevalent in the surgery group (64.6% vs. 10.4%).
Conclusions:
- Delayed radiographic evaluation, fracture displacement, and proximal pole involvement are key predictors for surgical treatment in pediatric scaphoid fractures.
- Radiographic findings like articular involvement and perifracture resorption also correlate with the need for surgery.
- These predictors can assist orthopedic surgeons in managing pediatric scaphoid fractures effectively.
Objectives:
To identify clinical and radiographic findings of pediatric scaphoid fractures that predict the need for surgical treatment.
Methods:
A retrospective review of pediatric patients (≤ 18 years) with scaphoid fractures, who underwent radiographic examination and treatment at our tertiary care pediatric hospital, between 2018 and 2024, identified all surgically treated patients. From the remaining conservatively treated patients, age matched comparisons were randomly selected. After randomization and blinded to outcome, skeletal age, fracture characteristics (location, displacement, comminution, articular involvement, perifracture radiodensity, lobulated perifracture resorption, fracture gap), and presence or absence of osteonecrosis were recorded. Findings were compared between surgically treated and conservatively treatd groups to identify predictors of surgery.
Results:
Ninety-six children (81 males, 15 females, mean age: 15.0 ± 1.8 years, range: 11.0-17.8) included 48 in the surgery and 48 in the non-surgery groups. Proximal pole fractures (8.3%, 8/96), perifracture radiodensity (26.0%, 25/96), and presence of osteonecrosis (12.5%, 12/96) were uncommon, but were only found among patients in the surgery group. Presence of displacement (81.3% vs. 12.2%, p < 0.01) and more severe displacement (2.2 vs. 0.7 mm, p < 0.01), articular involvement (37.5% vs. 8.3%, p < 0.01), and lobulated perifracture resorption (64.6% vs. 10.4%, p < 0.01) were more common among patients in the surgery than patients in the non-surgery groups. Logistic regression analyses found proximal pole fractures (OR = 6.67, 95% CI: 1.48-16.78, p = 0.04), fracture displacement (OR = 6.30, 95% CI: 1.32-33.87, p < 0.01), and longer delay to initial radiographs (OR = 1.08, 95% CI: 1.04-1.18, p = 0.01) were independent predictors of surgery.
Conclusion:
Children with scaphoid fractures are more likely to require surgery if radiographic evaluation is delayed, fracture is displaced, or involves the proximal pole.
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